Why some tests are repeated from another Lab & patients are
asked to buy drugs from particular stores which gives suspicion
of financial gains by doctors-Mazhar Abbas
Sindh Govt. has enacted a legislation; no FIR can be registered against
doctors unless professional negligence is confirmed – Haider Waheed
Proceedings of a Debate during LNH 5th Symposium
By Shaukat Ali Jawaid
KARACHI: An interesting debate related to health issues and perceptions about them by public, media and legal profession was one of the salient features of the recently concluded 5th Symposium of Liaquat National Hospital Karachi. This debate organized on January 10th was moderated by Dr. Ali Asghar, Consultant Endocrinologist at LNH who is also President-elect of Pakistan Endocrine Society. The panelists included Mr. Mazhar Abbas an eminent journalist, Prof. Saad Shafqat Proof Neurology at Aga Khan University Hospital, Mr. Haider Waheed a noted lawyer and Ms. Nasrien Askari Director and Co-founder of Mahratta Palace Museum at Karachi.
Dr. Ali Asghar Consultant Endocrinologist at LNH (Centre) moderating the debate on perceptions of media, lawyers and society about various health issues which was part of LNH symposium. Sitting on the dais panelists on right is Prof.Saad Shafqat, Ms. Nasrien Askari, and on left Haider Waheed & Mr. Mazhar Abbass.
The first question which the moderator put to the panelists was Do we over diagnose and ask for more tests? Prof. Saad Shafqat responded by stating that it is medicalization which helps to get the truth. Sometime even repeat tests are necessary to rule out certain diseases and come to the truth. We mostly practice on guess work and we will make mistakes. Technology helps. These diagnostic tests are much more sophisticated and they are also very expensive.
Mr. Haider Waheed agreed that to get the truth, one has to rely on tests. However, he hastened to add that in Pakistan doctors do get away with mistakes since there is no accountability like the one witnessed in the developed countries. Mr. Mazhar Abbas further stated that sometimes even with more tests, doctors fail to make diagnosis. Some healthcare facilities do indulge in over investigations for financial gains. Some of the public hospitals are reservoir of infections and even doctors working there don’t advise their friends to get their patients admitted there for risk of getting infection. He was of the view that doctors must look at the financial positon of the patient before asking for various investigations. Sometimes doctors are under pressure to do more tests, investigations so that they do not miss diagnosis. In some cases, even after undertaking all the tests and investigations, doctors come to the conclusion that no specific treatment was available for the diagnosed disease.
Dr. Saad Shafqat added that human body is very complicated. To rule out something, certain more tests becomes essential. However, the doctors must know what to do and when not to do any further tests and investigations. Mr. Haider Waheed remarked that over medication has its own side effects. There is no accountability of healthcare professionals in the country. Some disease can be picked up just on good history and comprehensive clinical examination if the doctors are competent and learnt the clinical skills during training. Timely tests do help in early diagnosis. Mr. Mazhar Abbas stated that in USA lot of un-necessary colonoscopies are performed, it is recommended for every adult after the age of forty-five years. Sometimes the doctors order the same tests and ask for getting them done from a particular laboratory.
Does it mean the tests done at the first lab are not reliable and there is no standardization of laboratories in Pakistan, he asked. It is also well known that sometimes physicians have financial interests in ordering tests and investigations from particular laboratories. He highlighted the importance of standardization and registration of all laboratories and investigation centers. It was also pointed out by Prof. Saad Shafqat that at times many things are out of control of doctors. We can only concentrate on some diseases, others can be controlled and there is no cure for them. However, the panelists agreed that there was a certain mafia involved in unethical practices. Lot of drugs are sold over the counter without any prescription, hence at times doctors direct the patients to buy drugs from some reliable source to overcome the problem of counterfeit drugs.
Mr. Haider Waheed stated that some cancers are not curable. We are sitting and discussing the situation in a city while the real scenario in the rural areas was entirely different. They have some indigenous practices. The next question from the moderator was regarding increasing cases of violence against healthcare professionals and healthcare facilities. Prof. Saad Shafqat remarked that private hospitals have made their own security arrangements but the situation was bad in public hospitals which are exposed to repeated cases of violence. Healthcare professionals working in public sector healthcare facilities do not feel protected. They work under constant threats, working environment is not at all comfortable for them to concentrate on their professional work. Mr. Mazhar Abbas stated that in Pakistan doctors seldom get punished for professional negligence and there is no way of getting any compensation by the patients from the doctors.
Mr. Haider Waheed remarked that Sindh Government has enacted a law to provide protection to HCPs and HCFs and no FIR can be registered against doctors unless professional negligence is confirmed. Mr. Mazhar Abbas said that strike by doctors and lawyers is extremely painful as it the patients and the clients of lawyers who suffer. Drug court proceedings are never covered by the Media. Ignorance of law is common and people avoid going to the courts. Another question asked from the participants was why medical certificates are issued to politicians and bureaucrats for treatment abroad? Is it true that treatment for those diseases is not available in the country? Why they don’t get treated within the country. It was stated that at times the situation is not so simple and the reasons are well known. Dr. Saad Shafqat reiterated that doctors have to make their own arrangements for their security.
Mr. Mazhar Abbas said that now doctors do explain to the patients the real situation which does help in reducing their anger. This communication gap needs to be eliminated. Prof. Saad Shafqat supported this view point and opined that doctors must explain the real situation to the patient’s attendants, family members. Mr. Mazhar Abbas said that unfortunately many doctors in Pakistan were killed after identification as they belonged to a particular sect, many others left the country. Even we saw certain hospitals being identified. We have seen that in some cases certain patients were taken to Abbasi Shaheed Hospital ignoring the JPMC which was the nearest healthcare facility for reasons which are well known.
The next question by the moderator was related to the quality of reporting. He referred to the breaking news on the television channels stating that a patient has died due to doctors or hospital negligence. How they come to such a conclusion so soon, he asked?
Mr. Mazhar Abbas responded by stating that unfortunately the standard of health reporting is not so good. We do not have trained journalists in health issues, many a times it is the crime reporters who are covering such issues. Owners of Media also prefer something which sells and improves their ranking. Negative stories sell fast. At times it is the people working on the desk who are responsible. He referred to the murder of Dr. Chishti Mujahid a freelance journalist in Quetta. He was murdered on the basis of a headline in his story but in fact headline did not match with the contents of the story. He agreed that we need training of journalists for technical reporting to improve the quality of reporting related to health issues in particular.
Future of women physiains also figured during the debate. It was stated that women physicians are not getting empowered. Ms Askari also supported this view. There is lot of gender bias in the medical profession with male physicians dominating in every field. The panelists agreed that some gender bias does exist but now many women physicians are also enjoying leadership role. They occupy coveted positons in medical institutions, hospitals. We can see their upward social mobility. Girls are learning how they can become more professional. They are liberated to some extent though they still face lot of problems. There is also difference in even basic salary and privileges of male and female doctors. Now Day Care centers are being established in many institutions to help working female doctors so that they children can be taken care while they are on duty and the situation will improve further in the days to come.
Responding to the next question Prof Saad Shafqat remarked that young people should never be stopped from going abroad. They bring foreign exchange. One can serve the country while living in the country or while serving overseas as well in many ways. He further stated that if opportunities are created, many young people will prefer to stay in the country rather than going abroad. Mr. Haider Waheed agreed that if we have stability, no law and order problem and opportunities for progress are there, many of them who are settled overseas would be interested to come back. I myself decided to come back because of my parents. We should try to be good enough. Many of the problems and difficulties we face are our own creation. The situation can be improved if everyone is sincere, works honestly, he added.
